Statement of Principles concerning opisthorchiasis (Reasonable Hypothesis) (No. 21 of 2025)

The instrument centres on three interlocking concepts: the medical definition of the condition, a limited set of factual factors sufficient to raise a reasonable hypothesis of service connection, and the statutory relationship of those factors to “relevant service” as defined in the instrument.

Medical definition. For claim assessment purposes, “opisthorchiasis” is defined as an infestation of the biliary system by the trematodes Opisthorchis felineus or Opisthorchis viverrini (Kind of injury, s 7(2)). The instrument notes common names and examples of symptoms, but elects the textual biological definition as determinative for claims. It also clarifies that, although the condition normally attracts ICD-10-AM code B66.0, the statutory meaning for these purposes is the definition provided in the instrument rather than the coding alone (Kind of injury, s 7).

Inclusion of death. The Statement expressly includes death from opisthorchiasis where the death resulted from a terminal event or condition that was contributed to by the person’s opisthorchiasis (Death from opisthorchiasis). The instrument imports the Schedule’s definition of “terminal event”, which lists proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure or cessation of brain function (Schedule 1 , Dictionary).

Factors sufficient to raise a reasonable hypothesis. The instrument provides a closed list of three factual factors. At least one of these must exist before a reasonable hypothesis is considered raised connecting the condition or death with relevant service (Factors that must exist, s 9). The three factors are:

• ingesting the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish at least three weeks before clinical onset, with an explanatory note about geographic distribution of contaminated fish (s 9(1));
• having a liver transplant where the liver was derived from a person infected with Opisthorchis viverrini or Opisthorchis felineus within the seven days before clinical onset (s 9(2));
• inability to obtain appropriate clinical management for opisthorchiasis before clinical worsening (s 9(3)).

Relationship to service. The instrument requires that any factor relied upon be related to the person’s relevant service (Relationship to service, s 10(1)). The Schedule defines “relevant service” to include operational, peacekeeping, hazardous and British nuclear test defence service under the VEA and warlike and non-warlike service under the MRCA (Schedule 1 , Dictionary). The instrument also contains a specific limitation on the application of the third factor (s 9(3)): it applies only where the person’s opisthorchiasis was suffered or contracted before or during, but did not arise out of, the relevant service, and where there is material contribution to or aggravation of the condition.

Cross-references to other Statements. If a factor in this Statement refers to an injury or disease covered by another Statement of Principles made under subsection 196B(2) of the VEA, the instrument instructs that the factors in that other Statement apply in accordance with their terms (Factors referring to an injury or disease covered by another Statement of Principles, s 11).

Authority and statutory basis. The Repatriation Medical Authority states that “there is sound medical-scientific evidence” indicating that opisthorchiasis and death from it can be related to relevant service. The instrument is made under subsection 196B(2) of the VEA and is intended to be applied in the statutory claims processes specified by the VEA and the MRCA (Authority, s 3; Basis for determining the factors, s 8; Application, s 5).

Primary claimants. The Statement affects persons who are claiming compensation, rehabilitation or related entitlements under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) where the claims are to be assessed under the provisions referenced in the instrument. The text specifically applies to claims to which section 120A of the VEA or section 338 of the MRCA apply (Application, s 5). Those statutory provisions determine the procedural and substantive route by which a Statement of Principles is applied in decision-making; the instrument itself provides the medical facts to be applied to such claims.

Veterans and current/former members of the Forces. The Schedule defines “relevant service” and thus identifies the categories of service whose personnel may be affected: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule 1 , Dictionary). Members of Peacekeeping Forces and members of the Forces under the VEA and MRCA are expressly contemplated by the Authority when stating the basis for the Statement (Basis for determining the factors, s 8).

Dependants and estates. Where a person’s death is alleged to have been contributed to by opisthorchiasis, the Statement applies to death claims. Thus dependants or personal representatives making death claims under the VEA or MRCA will be affected insofar as the Statement provides the relevant medical connection criteria for assessing service causation (Kind of injury, death provision).

Decision-makers and administrators. The Repatriation Medical Authority is the making body and the Statement is intended to be used by decision-makers assessing claims under the cited provisions of the VEA and MRCA. The instrument places the RMA in the role of determiner of the medical-scientific facts (Authority, s 3; Basis for determining the factors, s 8). The Statement will therefore influence internal decision processes, medico-legal assessments and the evidence that decision-makers will accept as raising a reasonable hypothesis.

Clinicians and evidence providers. Medical practitioners, treating clinicians, pathologists, transplant services and forensic practitioners will be affected because their records and opinions will be the primary evidentiary source for establishing the factual factors the Statement identifies, such as the timing of ingestion relative to clinical onset, transplant donor infection status and the availability or absence of “appropriate clinical management” prior to clinical worsening (Factors that must exist, s 9).

Geographic exposure groups. The instrument’s notes about where contaminated freshwater fish are mainly found,Southeast Asia for O. viverrini and Eastern and Central Europe and Southeast Asia for O. felineus,identify a subset of claimants whose service or movement history may make the listed factors more or less likely to be present. The Statement thereby affects claimants whose service exposed them to those regions, insofar as the ingestion factor refers explicitly to freshwater fish contaminated by those species (Factors that must exist, s 9(1) and note).

Other Statements and overlapping conditions. Where a factor refers to an injury or disease covered by another Statement of Principles, claimants may need to engage with multiple Statements; the instrument requires decision-makers to apply those other Statements’ factors as in force from time to time (Factors referring to an injury or disease covered by another Statement of Principles, s 11).

What the instrument does not change. The instrument does not itself create compensation entitlements, criminalise conduct, impose new reporting duties on clinicians beyond existing obligations, nor set procedural timelines for claim processing. It is a medical standard intended to be applied within the statutory framework of the VEA and MRCA. The practical effect on any individual claimant depends on the interaction between the instrument’s factors and the statutory decision-making processes in the VEA and MRCA.

Source of the Statement and duties of the Authority. The Repatriation Medical Authority has the duty, under subsection 196B(2) of the VEA, to determine Statements of Principles on the medical connection between injury, disease or death and relevant service. This instrument is made pursuant to that statutory duty (Authority, s 3). The instrument itself represents the Authority’s medical conclusions and is to be treated by decision-makers as the Authority’s determination of the medical-scientific facts relevant to applications under the cited statutory provisions.

Duties placed on claimants by operation of the Statement. The Statement requires that, for an assessment under the reasonable hypothesis test, at least one of the specific factors listed in s 9 must exist. It thereby places a de facto evidential duty on claimants to adduce material establishing one or more of those factors and to show that the factor(s) are related to the person’s relevant service (Factors that must exist, s 9; Relationship to service, s 10(1)). The instrument also clarifies the limited circumstances in which the “inability to obtain appropriate clinical management” factor (s 9(3)) may be relied on; that factor applies only where the condition was contracted before or during, but did not arise out of, the relevant service, and where the effect asserted is material contribution or aggravation (Relationship to service, s 10(2)).

Rights conferred or clarified for claimants. The Statement specifies the medical facts that, if established and related to relevant service, will raise a reasonable hypothesis. It clarifies the assessor’s threshold for medical causation in relation to opisthorchiasis. Practically, claimants have the right to have their claims considered using the Authority’s current Statement of Principles; decision-makers should apply this instrument when adjudicating claims within the referenced statutory provisions (Application, s 5). The instrument also cross-references other Statements where there is overlap, ensuring that a claimant relying on a factor that refers to a different condition will have that other Statement applied where relevant (Factors referring to another Statement, s 11).

Duties on decision-makers and administrators. Though the instrument does not itself set procedure, it is intended to be used in the statutory decision-making framework of the VEA and MRCA. Decision-makers adjudicating claims under s 120A of the VEA or s 338 of the MRCA will use this Statement as the medical benchmark for raising a reasonable hypothesis. Where a factor in this Statement refers to another Statement, the decision-maker must apply that other Statement’s factors as in force (s 11). The Statement’s repeal of the earlier 2016 instrument obliges decision-makers to use the 2025 Statement for claims commencing or assessed on or after its commencement date (Repeal, s 4; Commencement, s 2).

Evidentiary and document duties implied by the factors. The factors in s 9 implicitly translate into a requirement for documentation and evidence such as medical and treatment records, transplant documentation or credible exposure histories. For example, the ingestion factor requires evidence that the person ingested specified types of freshwater fish at least three weeks before clinical onset; the transplant factor necessitates documentation that the transplant liver was derived from an infected donor and that the timing was within seven days before clinical onset; and the clinical management factor requires records demonstrating inability to obtain appropriate care before worsening (s 9(1)-(3)).

Limits on duties. The Statement does not identify obligations on third parties such as treating clinicians to produce particular reports. It also does not itself prescribe the standard of proof for entitlement; it supplies the medical facts required to raise a reasonable hypothesis, which is a threshold concept for the statutory decision-makers referenced. The instrument does not create criminal or civil penalties for non-compliance.

Cross-application duties. Where a factor refers to another Statement (for example a factor concerned with another disease), the decision-maker must apply that other Statement as in force from time to time, which may affect the duties of decision-makers to consult and apply multiple Statements when adjudicating complex claims (s 11).

The instrument does not create criminal offences, civil penalties or direct enforcement mechanisms. It is a Statement of Principles under subsection 196B(2) of the VEA and is designed to guide the statutory decision-making processes in the VEA and the MRCA rather than to impose sanctioning obligations on individuals or entities (Authority, s 3; Application, s 5). There is no provision in the instrument that prescribes fines, imprisonment or administrative penalties for failing to meet any of the factual factors or for failing to provide evidence.

Administrative enforcement through decision-making. Enforcement, in practice, will occur through the application of the instrument by decision-makers when determining entitlement under the VEA and MRCA. If a claimant cannot establish at least one of the factors in s 9 or cannot show a nexus between the factor and relevant service, a decision-maker may determine that the reasonable hypothesis requirement is not met and decline to accept service connection. Conversely, where the factor(s) and linkage are established, a decision-maker will proceed under the statutory framework for entitlements. The instrument thereby functions as an evidentiary threshold for administrative decisions rather than a penal instrument.

No remedy provisions within the Statement. The Statement contains no express remedial programme, compensation schedule or administrative appeal procedure. Remedies, appeal rights and enforcement mechanisms are provided by the VEA and MRCA themselves; this Statement is to be applied within those statutory schemes. The instrument does not alter statutory appeal rights under those Acts and does not specify how decision-makers must resolve disputes of fact or law arising in claims.

Potential consequences of misapplication. The instrument does not stipulate sanctions for incorrect application by decision-makers. However, improper use of the Statement in statutory decision-making could give rise to administrative review or judicial review within the remedies available under the VEA and MRCA and general administrative law. The instrument itself does not enumerate those processes.

No investigatory powers or reporting duties. The Statement does not confer investigatory powers on the Repatriation Medical Authority or other agencies, nor does it impose new reporting or notification duties on clinicians, transplant services or other bodies. It is a medical determinative tool and not a regulatory instrument with enforcement obligations.

Statutory source and application. The Statement is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986 and expressly applies to claims governed by section 120A of the VEA and section 338 of the Military Rehabilitation and Compensation Act 2004 (Application, s 5; Authority, s 3). Those statutory provisions determine the role and weight of a Statement of Principles in claims decision-making. The instrument therefore operates within the statutory framework of the VEA and the MRCA, and its practical effect depends on the application of those Acts by decision-makers.

Integration with other Statements of Principles. The instrument contains an express interaction rule: if a factor in this Statement refers to an injury or disease covered by another Statement of Principles made under subsection 196B(2) of the VEA, then the factors in that other Statement apply in accordance with their terms as in force from time to time (Factors referring to another Statement, s 11). This requires decision-makers to consult and apply other Statements where there is overlap between conditions or where factors invoke conditions governed elsewhere.

Coding and diagnostic classification. The instrument notes that opisthorchiasis typically attracts ICD-10-AM code B66.0 but instructs that the statutory meaning of the condition for the purposes of the Statement is the definition provided in the instrument and not the ICD code alone (Kind of injury, s 7 and note). It explicitly references the ICD-10-AM Tenth Edition (effective 1 July 2017) as published by the Independent Hospital Pricing Authority when referring to codes. Thus, users of diagnostic coding should treat the code as informational and rely on the instrument’s definition when assessing claims.

Interaction with transplant and donor law/procedures. One of the factors in the Statement concerns liver transplants where the liver is derived from an infected donor within seven days of clinical onset (Factors that must exist, s 9(2)). While the Statement does not alter donor consent or transplantation law, it requires decision-makers and claimants to consider transplant records and donor infection status when assessing causal connection. The Statement does not prescribe hospital reporting obligations but makes transplant documentation potentially material evidence in claims under the VEA and MRCA.

Overlap with public health and infectious disease regimes. The Statement identifies a communicable parasitic infestation and notes geographic concentrations of contaminated fish. It does not alter public health law, quarantine law, or other infectious disease controls. It simply provides the medical facts to be used when assessing claims under the statutory compensation schemes.

Repeal and temporal interaction with earlier instruments. The Statement expressly repeals the prior Statement of Principles concerning opisthorchiasis (No. 45 of 2016). Decision-makers must therefore apply this 2025 Statement from its commencement on 25 March 2025 and not the 2016 instrument (Repeal, s 4; Commencement, s 2). The instrument’s repeal provision creates a temporal boundary that will influence how claims that span the repeal date are assessed; whether past decisions are revisited will be governed by the VEA, MRCA and administrative procedures rather than this Statement.

No interaction with criminal law or private tort law within the instrument. The Statement does not create civil causes of action or alter the elements of tort or criminal liability. It is confined to medical causation for administrative claims determination.

Definitions and their statutory interaction. The Schedule supplies definitions,most saliently “relevant service” and “terminal event”,that shape how the Statement interacts with the VEA and MRCA categories of service and with how death is characterised when assessing claims (Schedule 1 , Dictionary). Users must read the Statement in conjunction with those definitional provisions to determine the applicability of the Statement to particular claimants.

This instrument replaces and repeals the prior Statement of Principles on the same condition. The Repatriation Medical Authority has expressly repealed the Statement of Principles concerning opisthorchiasis (Reasonable Hypothesis) (No. 45 of 2016) (Federal Register of Legislation No. F2016L00579) (Repeal, s 4). The current instrument is dated 18 February 2025 and commences on 25 March 2025 (front matter; Commencement, s 2). Those are the explicit historical events recorded in the instrument.

No other amendments or versions are recorded within the text. The instrument does not provide a legislative history or explanatory note within the body of the text beyond the matters set out in the header and the body clauses. There is no schedule of incremental amendments or transitional rules provided beyond the repeal of the 2016 Statement.

Effect of repeal. The repeal provision means that, from the commencement date, decision-makers must apply the 2025 Statement rather than the 2016 Statement. The instrument does not provide transitional wording for claims made before commencement. How claims that were assessed under the 2016 Statement are to be treated, or whether previously finalised decisions are to be reopened, is not addressed in this instrument and therefore will depend on the statutory provisions and administrative procedures under the VEA and MRCA.

Potential future amendments. The instrument itself contains no mechanism for automatic update beyond ordinary legislative or administrative action by the Repatriation Medical Authority and does not prescribe a review timetable. The instrument indicates that other Statements referred to will apply “as in force from time to time” (s 11), which signals that Statements are living instruments that may be amended. Any future amendment to this Statement would presumptively be made by the Repatriation Medical Authority under the same statutory power, subsection 196B(2) of the VEA (Authority, s 3).

Record and publication. The instrument identifies the Federal Register of Legislation entry for the repealed 2016 Statement. The current instrument’s commencement date and repeal of the earlier Statement make clear the administrative record-keeping and publication pathway: the 2025 Statement is the operative authoritative medical instrument for claim assessment after the commencement date. The instrument itself does not annex explanatory memorandum extracts or evidence lists that underpinned the RMA’s view that “there is sound medical-scientific evidence” (Basis for determining the factors, s 8).

Limitations on retrospective application. The Statement does not have provisions prescribing retrospective application or savings provisions. The instrument’s effect from its commencement date is clear, but whether and how it is to be applied to claims or decisions arising before 25 March 2025 depends on the statutory framework of the VEA and MRCA and administrative practice.

The Statement contains no litigation history and does not cite any case law. It is a determinative administrative medical instrument intended to be used within statutory decision-making frameworks. The text records only the Authority’s medical view and the legislative basis for the Statement; it does not record any challenges, judicial reviews, appeals, judgments or precedent concerning the Statement itself.

Areas where litigation or review may arise. Although the instrument does not document any litigation, its content identifies factual and legal issues that could give rise to disputes in the context of claims adjudication. For example:

• the factual sufficiency and interpretation of the listed factors (s 9): there may be disputes over whether ingestion evidence meets the minimum timing requirement of “at least 3 weeks before clinical onset” (s 9(1)); whether a transplant donor’s infection status and timing satisfy the seven day window in s 9(2); or whether the circumstances demonstrate “inability to obtain appropriate clinical management before clinical worsening” (s 9(3));
• the relationship to service (s 10): there may be contested questions about whether an established factor is sufficiently related to the claimant’s relevant service as defined in the Schedule; and whether a condition “arose out of” service versus being suffered or contracted before or during service for the purpose of s 10(2);
• cross-referencing to other Statements (s 11): disputes could arise over which Statement applies when factors refer to injuries or diseases addressed in other Statements, and which version of another Statement (as in force from time to time) controls.

Nature of the dispute likely to be administrative. Any disagreement over whether the Statement’s factors are established in a particular claim will generally engage the statutory decision-making mechanisms and internal review rights under the VEA and MRCA. Further legal recourse would depend on those Acts and general administrative law principles. The Statement itself does not prescribe appeal paths or judicial review processes.

No recorded judicial testing recorded in the instrument. The absence of litigation history in the text means there is no source-provided precedent on how courts or tribunals have interpreted or applied this specific Statement. Any assessment of how courts might treat this instrument would require external legal research beyond the instrument’s text.

Evidentiary disputes. The factors identified are factual in nature and will turn on medical evidence, service records, transplant documentation and contemporaneous clinical notes. The instrument anticipates that claim outcomes will be determined by application of the factors to available evidence rather than by the instrument providing procedural dispute-resolution mechanisms.

Narrow, enumerated factors. The instrument sets a closed list of three factors that must exist to raise a reasonable hypothesis (s 9). If a claimant cannot establish at least one of these specific factual circumstances, the Statement’s test is not met. Practitioners should not assume that other exposure routes or clinical presentations will be sufficient unless they fall within these enumerated factors or are covered by another applicable Statement.

Timing windows are strict and condition-specific. The ingestion factor requires ingestion “at least 3 weeks before clinical onset” (s 9(1)); the transplant factor requires the liver to have been derived from an infected person “within the 7 days before clinical onset” (s 9(2)). These are discrete temporal thresholds. The instrument does not provide sliding scales for different incubation periods or uncertainty; establishing the timing of clinical onset and exposure is therefore critical.

Geographic notes are advisory but evidentially relevant. The instrument notes that freshwater fish contaminated by O. viverrini are mainly found in Southeast Asia and fish contaminated by O. felineus are mainly found in Eastern and Central Europe and Southeast Asia (note to s 9(1)). That note is descriptive rather than determinative, but it signals where exposure is more likely. Claimants whose service did not include those regions may face an evidentiary gap in establishing the ingestion factor.

Clinical management factor is limited in scope. The inability to obtain appropriate clinical management before clinical worsening (s 9(3)) is the only factor that relates to health-system access. Its application is restricted by s 10(2): it applies only where the condition was suffered or contracted before or during, but did not arise out of, the relevant service and only where there is material contribution to, or aggravation of, the condition. This is a narrowly framed exception that will require careful factual proof both of the timing and of the causal significance of the lack of treatment.

ICD code is not determinative. The instrument notes the usual ICD-10-AM code but instructs that the statutory meaning is the textual definition in the Statement (Kind of injury, s 7 and note). Relying solely on diagnostic coding without corroborating clinical detail that matches the instrument’s definition is insufficient.

Death claims rely on the terminal event link. For a death to be covered, the deceased person’s opisthorchiasis must have contributed to a terminal event as defined in the Schedule (e.g. pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Claimants must therefore demonstrate contribution to a listed proximate or ultimate cause rather than merely showing the presence of infection at death.

Relevance of other Statements may complicate proof. If a factor refers to an injury or disease covered by another Statement, the decision-maker must apply that other Statement “as in force from time to time” (s 11). Practically, this can lead to layered evidentiary requirements and the need to consider multiple Statements and their versions. Practitioners must check whether other Statements have been amended since the claimant’s exposure or diagnosis.

Repeal of the 2016 Statement. The instrument repeals the 2016 Statement (s 4). Practitioners must confirm whether a claim’s assessment dates fall before or after the commencement date to determine which Statement applies to the claim. The instrument contains no transitional rules; administrative practice under the VEA and MRCA will determine how the repeal affects ongoing or previously decided claims.

Ambiguities in “appropriate clinical management”. The phrase “inability to obtain appropriate clinical management” is not defined in the instrument and may raise factual disputes about what constitutes appropriate management for opisthorchiasis in a given setting and time. The absence of a statutory definition means this will be a fact-intensive question sensitive to contemporaneous clinical standards and local health-service availability.

Burden of proof remains with claimant evidence. The Statement sets the medical facts that will raise a reasonable hypothesis if established; it does not instruct decision-makers to accept uncorroborated assertions. Claimants must marshal clinical, service and other documentary evidence to meet the thresholds the Statement specifies.

For claimants and representatives

1. Identify whether the claim is one to which this Statement applies. Confirm that the claim is assessed under section 120A of the VEA or section 338 of the MRCA, and that the person’s service falls within the Schedule definition of relevant service (Application, s 5; Schedule 1 , Dictionary).

2. Establish at least one of the enumerated factors in s 9. Produce contemporaneous or retrospective evidence that addresses the precise wording and temporal thresholds:

   • For ingestion (s 9(1)): obtain a detailed exposure history showing ingestion of the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish, and establish that the ingestion occurred at least three weeks before the clinical onset documented in medical records. Where possible, corroborate the history with contemporaneous notes, witness statements, travel or mess records and laboratory or imaging findings consistent with opisthorchiasis.
   • For transplant (s 9(2)): obtain transplant records showing donor infection status, the date of transplant and clinical onset timing. Demonstrate that the liver was derived from an infected person and that the transplant occurred within seven days before clinical onset.
   • For inability to obtain appropriate clinical management (s 9(3)): assemble medical records showing dates of presentation, referrals, notes demonstrating that appropriate clinical care was not available or could not be accessed before clinical worsening, and evidence of the material contribution or aggravation attributable to the lack of management. Because s 10(2) limits this factor’s application, also show that the condition was suffered or contracted before or during, but did not arise out of, relevant service.

3. Demonstrate relationship to relevant service (s 10). Provide service records, deployment logs, peacekeeping or operation rosters, and any documents that connect the exposure circumstances to the person’s relevant service. The Schedule’s definition of relevant service identifies the statutory categories that qualify.

4. For death claims, link opisthorchiasis to a terminal event (Death from opisthorchiasis; Schedule 1 , Dictionary). Produce clinical, pathology and cause of death documentation showing that the person’s opisthorchiasis contributed to a proximate or ultimate cause of death listed in the Schedule’s definition of “terminal event”.

5. Where factors reference other Statements, source and apply those Statements. If any factor points to another Statement of Principles under subsection 196B(2), obtain the current version of that Statement and apply its factors to the claim (s 11).

6. Do not rely solely on ICD coding. While code B66.0 may be recorded, ensure the diagnosis and clinical features correspond to the instrument’s definition of opisthorchiasis (Kind of injury, s 7 and ICD note).

For clinicians and evidence providers

1. Document clinical onset precisely. Record the first date symptoms consistent with opisthorchiasis appeared and document symptom progression and relevant investigations.

2. Record exposure and timing. Where a history suggests ingestion of freshwater fish as described, document the nature of the fish (freshwater), preparation (raw, undercooked, iced, pickled or smoked), timing of ingestion relative to onset, and any corroborating context (geographic location, availability of species noted by the instrument).

3. For transplant cases, provide explicit donor and graft information. Record donor infection testing where available, the date of transplant, and clinical observations that link graft-derived infection to the recipient’s clinical onset within the seven day window stated in s 9(2).

4. For inability to obtain care cases, detail attempts to obtain treatment and contemporaneous barriers. Note referrals, facility capacities, dates of attempted access, unavailability of appropriate services and the clinical consequences of delayed or absent treatment. Make the connection to clinical worsening explicit in notes.

For decision-makers and administrators

1. Apply the Statement as the RMA’s medical determination under subsection 196B(2). Use the instrument to determine whether a reasonable hypothesis is raised on the medical facts supplied in the claim (Authority, s 3; Basis for determining the factors, s 8).

2. Check the timing of the Statement’s commencement and repeal. Use the 2025 Statement for claims falling on or after 25 March 2025 and note that the 2016 Statement has been repealed (Commencement, s 2; Repeal, s 4).

3. Require evidence that aligns with the Statement’s wording. Assess whether the evidence presented establishes one or more of the s 9 factors and whether the factor is related to the person’s relevant service (s 9; s 10).

4. Where a factor refers to another Statement, consult that Statement. Apply the other Statement’s factors “as in force from time to time” (s 11) and reconcile overlapping requirements.

5. Treat ICD codes as supportive but not dispositive. Confirm diagnosis against the Statement’s textual definition rather than relying solely on coding (Kind of injury, s 7).

6. Where factual disputes arise, identify the precise factual gap. Common areas of dispute will include timing of exposure and onset, donor infection documentation, and evidence of inability to access appropriate clinical management. Requests for additional information or independent medical examination requests should be tailored to those specific evidentiary gaps.

Record-keeping and evidentiary best practice

1. Preserve contemporaneous medical and service records. These are the principal materials that will satisfy the Statement’s temporal thresholds.

2. Where oral histories are used, obtain corroboration. Witness statements, travel documentation and unit logs that place a person in a geographic area with the species identified in the instrument will strengthen claims relying on ingestion.

3. For claims invoking inability to obtain care, compile facility records and correspondence showing attempts to obtain treatment and the reasons treatment was not provided.

4. For death claims, obtain complete pathology and cause of death documentation that shows the contribution of opisthorchiasis to a listed terminal event.

Administrative considerations

1. Confirm statutory decision pathways under the VEA and MRCA. The Statement is a medical instrument to be applied within those frameworks; adhere to the procedural and appeal provisions of the governing Acts.

2. For claims straddling the repeal or commencement date, consider the administrative discretion and statutory rules that apply to the temporal operation of Statements; the instrument contains no transitional rules and administrative practice will be determinative.

3. Ensure cross-disciplinary coordination. Transplant services, infectious disease clinicians and medico-legal advisers may need to cooperate to assemble the requisite evidence.

4. If multiple Statements are potentially applicable, sequence the application logically and document the reasons for relying on each Statement and each factor.

By following these steps and focusing evidence on the precise textual elements of the Statement,timings, documented diagnoses, transplant donor infection status, evidence of inability to access appropriate clinical management and service linkage,parties can present claims and adjudicators can assess them in a manner aligned with the Statement’s structure and wording.